Chest Physiotherapy

  1. General information
    1. Used for individuals with increased production of secretions or thick, sticky secretions, and for clients with impaired removal of secretions or with ineffective cough. May also be used as a preventive measure for clients with weakness of the muscles of respiration or a predisposition to increased production or thickness of secretions.
    2. Includes the techniques of postural drainage, percussion, and vibration.
      1. Postural drainage: uses gravity and various positions to stimulate the movement of secretions.
        1. postural drainage positions are determined by the areas of involved lung, assessed by chest x-ray and physical assessment findings.
        2. careful positioning is required to help secretions flow from smaller airways into the segmental bronchus and larger airways where secretions can be coughed up.
      2. Percussion: involves clapping with cupped hands on the chest wall over the segment to be drained.
        1. the hand is cupped by holding the fingers together so that the shape of the hand conforms with chest wall.
        2. clapping should be vigorous but not painful.
      3. Vibration: in this technique the hand is pressed firmly over the appropriate segment of chest wall, and muscles of upper arm and shoulder are tensed (isometric contraction); done with flattened, not cupped hand.
  2. Nursing care
    1. Perform procedure before or 3 hours after meals.
    2. Administer bronchodilators about 20 minutes before procedure.
    3. Remove all tight/constricting clothing.
    4. Have all equipment available (tissues, emesis basin, towel, paper bag).
    5. Assist client to correct prescribed position for postural drainage (client to assume each postural drainage position for approximately 3-5 minutes).
    6. Place towel over area to be percussed.
    7. Instruct client to take several deep breaths.
    8. Percuss designated area for approximately 3 minutes during inspiration and expiration.
    9. Vibrate same designated area during exhalations of 4-5 deep breaths.
    10. Assist client with coughing when in postural drainage position; some clients may need to sit upright to produce a cough.
    11. Repeat the same procedure in all designated positions.
    12. After procedure, assist client to comfortable position and provide good oral hygiene.